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Rothke M.,Abteilung Radiologie | Blondin D.,Universitatsklinikum Dusseldorf | Schlemmer H.-P.,Abteilung Radiologie | Franiel T.,Charité - Medical University of Berlin
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2013

Purpose: To flesh out the ESUR guidelines for the standardized interpretation of multiparametric magnetic resonance imaging (mMRI) for the detection of prostate cancer and to present a graphic reporting scheme for improved communication of findings to urologists. Materials and Methods: The ESUR has recently published a structured reporting system for mMRI of the prostate (PI-RADS). This system involves the use of 5-point Likert scales for grading the findings obtained with different MRI techniques. The mMRI includes T2-weighted MRI, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and MR spectroscopy. In a first step, the fundamentals of technical implementation were determined by consensus, taking into account in particular the German-speaking community. Then, representative images were selected by consensus on the basis of examinations of the three institutions. In addition, scoring intervals for an aggregated PI-RADS score were determined in consensus. Results: The multiparametric methods were discussed critically with regard to implementation and the current status. Criteria used for grading mMRI findings with the PI-RADS classification were concretized by succinct examples. Using the consensus table for aggregated scoring in a clinical setting, a diagnosis of suspected prostate cancer should be made if the PI-RADS score is 4 or higher (≥ 10 points if 3 techniques are used or ≥ 13 points if 4 techniques are used). Finally, a graphic scheme was developed for communicating mMRI prostate findings. Conclusion: Structured reporting according to the ESUR guidelines contributes to quality assurance by standardizing prostate mMRI, and it facilities the communication of findings to urologists. © Georg Thieme Verlag KG Stuttgart · New York.

Walther T.,Kerckhoff Herzzentrum | Hamm C.W.,Abteilung Radiologie | Schuler G.,Abteilung Radiologie | Berkowitsch A.,Abteilung Radiologie | And 10 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Transcatheter aortic valve replacement (TAVR) has evolved into a routine procedure with good outcomes in high-risk patients. Objectives TAVR complication rates were evaluated based on prospective data from the German Aortic Valve Registry (GARY). Methods From 2011 to 2013, a total of 15,964 TAVR procedures were registered. We evaluated the total cohort for severe vital complications (SVCs), including the following: death on the day of intervention, conversion to sternotomy, low cardiac output that required mechanical support, aortic dissection, and annular rupture; technical complications of the procedures (TCOs), such as repositioning or retrieval of the valve prosthesis and embolization of the prosthesis; and other complications. Results Mean patient age was 81 ± 6 years, 54% of the patients were women, the median logistic Euroscore I was 18.3, the German aortic valve score was 5.6, and the Society of Thoracic Surgeons score was 5.0. Overall in-hospital mortality was 5.2%, whereas SVCs occurred in 5.0% of the population. Independent predictors for SVCs were female sex, pre-operative New York Heart Association functional class IV, ejection fraction <30%, pre-operative intravenous inotropes, arterial vascular disease, and higher degree of calcifications. TCOs occurred in 4.7% of patients and decreased significantly from 2011 to 2013. An emergency sternotomy was performed in 1.3% of the patients; however, multivariate analysis did not identify any predictors for conversion to sternotomy. Conclusions The all-comers GARY registry revealed good outcomes after TAVR and a regression in complications. Survival of approximately 60% of patients who experienced SVCs or who required sternotomy underlines the need for heart team-led indication, intervention, and follow-up care of TAVR patients. © 2015 American College of Cardiology Foundation.

Starting in 2012, several nature conservation organisations have worked together with experts to develop proposals for voluntary monitoring on areas under Germany's National Natural Heritage scheme. One of the core principles here is the suitability of the methodological approaches for processing by volunteers; another is the comparability of the results with data from existing monitoring programmes. The forest monitoring concept is now largely finalised. The article presents the state of discussion and the experiences of first test runs. © 2014. Kohlhammer, Stuttgart.

Busch H.-P.,Abteilung Radiologie
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2013

Hospitals around the world are under increasing pressure to optimize the economic efficiency of treatment processes. Imaging is responsible for a great part of the success but also of the costs of treatment. In routine work an excessive supply of imaging methods leads to an "as well aso" strategy up to the limit of the capacity without critical reflection. Exams that have no predictable influence on the clinical outcome are an unjustified burden for the patient. They are useless and threaten the financial situation and existence of the hospital. In recent years the focus of process optimization was exclusively on the quality and efficiency of performed single examinations. In the future critical discussion of the effectiveness of single exams in relation to the clinical outcome will be more important. Unnecessary exams can be avoided, only if in addition to the optimization of single exams (efficiency) there is an optimization strategy for the total imaging process (efficiency and effectiveness). This requires a new definition of processes (Imaging Pathway), new structures for organization (Imaging Center) and a new kind of thinking on the part of the medical staff. Motivation has to be changed from gratification of performed exams to gratification of process quality (medical quality, service quality, economics), including the avoidance of additional (unnecessary) exams. © Georg Thieme Verlag KG Stuttgart. New York.

Despite the unchanged retention of the fundamental technical and physical principles since its first clinical application in the year 1972, computed tomography (CT) constitutes a mainstay of present day radiological diagnostics. In conjunction with the sub-second gantry rotation times now achieved numerous technical improvements, such as helical scanning and the development of high-performance X-ray tubes as well as multi-row detectors with up to 320 rows allow large areas to be examined with high image quality within only a few seconds. On the basis of these advancements modern multidetector-row CT (MDCT) enables high-resolution slice or volume imaging of the anatomy as well as multiphase and perfusion examinations. An end to innovations in the field of MDCT is not yet foreseeable and further technical developments will open up new radiodiagnostic indications thereby broadening the spectrum of clinical applications of MDCT in the future. © 2011 Springer-Verlag.

Schulte-Baukloh H.,Abteilung Radiologie
Urologe - Ausgabe A | Year: 2012

Botulinum neurotoxin (BoNT) has become increasingly established in the treatment of neurogenic bladder dysfunctions over the last 12 years. Today it represents an alternative to conservative medical therapy and reduces the indications for broader surgical measures. Since September 2011, BoNT/A is approved for the use in neurogenic bladder disorders. This article therefore summarises the main findings once more, particularly with regard to practical application.The by far most commonly used BoNT subtype is botulinum neurotoxin A (BoNT/A), which has shown the most convincing effects after detrusor injections in the urological field. It unfolds its full effect after about 7 days. Subjective parameters, such as urination frequency, incontinence and quality of life are improved most substantially, which is objectively reflected by the increase in bladder capacity and the reduction of maximum detrusor pressure. Significantly decreasing effectiveness and necessity for repeated injections must be expected after about 9 months. Repeated applications have proven to be effective. Systematic side effects are rare and do not reach dramatic extents. The major urologic side effect, which is not uncommon, is the increase in residual urine, which can lead to urinary retention in patients with spontaneous voiding. © Springer-Verlag 2012.

The second part of this educational article focuses on sequence techniques in magnetic resonance imaging (MRI) and on suitable parameter sets for different contrast weightings. The content is based on the recently published part 1 of this educational article providing a survey on tissue properties relevant for most important contrast mechanisms. Characteristics of contrast weightings are presented in exemplary images recorded from healthy volunteers. Typical clinical applications of the most commonly used contrast weightings are described and discussed. Sequences for the following contrast weightings are included: proton density (density of hydrogen in small mobile molecules), relaxation times T 1 and T2, chemical shift (water and fat), effects of magnetic susceptibility, restricted diffusion of water molecules and magnetization transfer between macromolecules and water molecules. © 2013 Springer-Verlag Berlin Heidelberg.

Confabulations are no unitary syndrome, but comprise different forms of verbal statements with a varying aetiology. They can pertain to autobiographical events, semantic knowledge, the past, presence and future and are fabricated, distorted or misinterpreted memories or perceptions without conscious intent to deceive. Confabulations are caused by different mechanisms: on the one hand by disturbed memory processing (mainly by monitoring disturbances) such as impairments in source monitoring or in the strategic retrieval of memories, on the other hand by perceptual disorders (such as neglect). Confabulations act as sense-makers in a current situation, as self-makers to keep ones identity in interaction with others and as world-makers to organize and legitimate actions. © Georg Thieme Verlag KG Stuttgart - New York.

The pathophysiology of lower urinary tract symptoms (LUTS) is multifactorial. The fact that none of the available drugs impacts on more than one of these pathomechanisms, provides the rationale for combined medical treatment strategies. The combination of α-blocker and a 5-reductase inhibitor is recommended by all major benign prostate hyperplasia (BPH/LUTS) guidelines as a first line approach for men with moderate to severe LUTS and a higher risk for disease progression. The efficacy of this approach has been proven in prospective randomized trials for up to 4 years. The combination of α-blocker and antimuscarinics has been tested in several randomized trials as a primary approach or as add on therapy but the maximum study duration was only 3 months. The add on approach is suitable in particular for men with persisting storage symptoms under α-blockade. The risk for acute retention in appropriately selected men is low. The scientific basis for all other combinations is not solid enough to recommend the use outside clinical trials. © 2013 Springer-Verlag Berlin Heidelberg.

In comparison to roentgen-based radiological examination techniques, magnetic resonance imaging (MRI) provides a wide variety of tissue contrast. This can be utilized for better detection and characterization of pathological findings. The basis of image contrast in MRI is the chemical and physical properties of the hydrogen atoms in tissue, in particular in their chemical bonds in water and lipid molecules and in the environment in which the hydrogen-containing molecules are contained. This environment is mainly determined by the composition of substances, viscosity and temperature as well as the microscopic geometrical conditions in tissue. Part 1 of this advanced education article describes those contrast mechanisms which are most commonly utilized in static clinical standard examinations of various organ systems. © 2013 Springer-Verlag Berlin Heidelberg.

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